Title: Prevalence and risk factors of refractive errors among older Chinese in Hebei, China: a cross‐sectional study from the China National Health Survey
Abstract: Acta OphthalmologicaVolume 98, Issue 3 p. e394-e395 Letter to the EditorFree Access Prevalence and risk factors of refractive errors among older Chinese in Hebei, China: a cross-sectional study from the China National Health Survey Yuyu Chou, Yuyu Chou Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, ChinaThese authors are co-first authors.Search for more papers by this authorJin Ma, Jin Ma Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, ChinaThese authors are co-first authors.Search for more papers by this authorJiantao Cui, Jiantao Cui Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, ChinaSearch for more papers by this authorLi Pan, Li Pan Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, ChinaSearch for more papers by this authorZixi Sun, Zixi Sun Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, ChinaSearch for more papers by this authorCui Ze, Cui Ze Hebei Center for Disease Prevention and Control, Shijiangzhuang, ChinaSearch for more papers by this authorJixin Sun, Jixin Sun Hebei Center for Disease Prevention and Control, Shijiangzhuang, ChinaSearch for more papers by this authorYajin Cao, Yajin Cao Hebei Center for Disease Prevention and Control, Shijiangzhuang, ChinaSearch for more papers by this authorJingjing Zhao, Jingjing Zhao Hebei Center for Disease Prevention and Control, Shijiangzhuang, ChinaSearch for more papers by this authorXinyan Ma, Xinyan Ma Institute of Chronic Disease, Shijiazhuang Center for Disease Prevention and Control, Shijiazhuang, ChinaSearch for more papers by this authorJifei Ma, Jifei Ma Institute of Chronic Disease, Baoding Center for Disease Prevention and Control, Baoding, ChinaSearch for more papers by this authorHuijing He, Huijing He Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, ChinaSearch for more papers by this authorYong Zhong, Corresponding Author Yong Zhong [email protected] orcid.org/0000-0002-9511-4726 Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China Correspondence: Yong Zhong Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College No. 1 Shuaifu Yuan, Dongcheng District, 100730 Beijing, China Tel: +86 13701182946 Email: [email protected] Guangliang Shan Department of Epidemiology and Statistics Institute of Basic Medical Sciences Chinese Academy of Medical Sciences 5 Dongdansantiao, Dongcheng District, Beijing 100005 China Tel: +86 18611968902 Email: [email protected].Search for more papers by this authorGuangliang Shan, Corresponding Author Guangliang Shan [email protected] Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China Correspondence: Yong Zhong Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College No. 1 Shuaifu Yuan, Dongcheng District, 100730 Beijing, China Tel: +86 13701182946 Email: [email protected] Guangliang Shan Department of Epidemiology and Statistics Institute of Basic Medical Sciences Chinese Academy of Medical Sciences 5 Dongdansantiao, Dongcheng District, Beijing 100005 China Tel: +86 18611968902 Email: [email protected].Search for more papers by this author Yuyu Chou, Yuyu Chou Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, ChinaThese authors are co-first authors.Search for more papers by this authorJin Ma, Jin Ma Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, ChinaThese authors are co-first authors.Search for more papers by this authorJiantao Cui, Jiantao Cui Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, ChinaSearch for more papers by this authorLi Pan, Li Pan Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, ChinaSearch for more papers by this authorZixi Sun, Zixi Sun Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, ChinaSearch for more papers by this authorCui Ze, Cui Ze Hebei Center for Disease Prevention and Control, Shijiangzhuang, ChinaSearch for more papers by this authorJixin Sun, Jixin Sun Hebei Center for Disease Prevention and Control, Shijiangzhuang, ChinaSearch for more papers by this authorYajin Cao, Yajin Cao Hebei Center for Disease Prevention and Control, Shijiangzhuang, ChinaSearch for more papers by this authorJingjing Zhao, Jingjing Zhao Hebei Center for Disease Prevention and Control, Shijiangzhuang, ChinaSearch for more papers by this authorXinyan Ma, Xinyan Ma Institute of Chronic Disease, Shijiazhuang Center for Disease Prevention and Control, Shijiazhuang, ChinaSearch for more papers by this authorJifei Ma, Jifei Ma Institute of Chronic Disease, Baoding Center for Disease Prevention and Control, Baoding, ChinaSearch for more papers by this authorHuijing He, Huijing He Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, ChinaSearch for more papers by this authorYong Zhong, Corresponding Author Yong Zhong [email protected] orcid.org/0000-0002-9511-4726 Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China Correspondence: Yong Zhong Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College No. 1 Shuaifu Yuan, Dongcheng District, 100730 Beijing, China Tel: +86 13701182946 Email: [email protected] Guangliang Shan Department of Epidemiology and Statistics Institute of Basic Medical Sciences Chinese Academy of Medical Sciences 5 Dongdansantiao, Dongcheng District, Beijing 100005 China Tel: +86 18611968902 Email: [email protected].Search for more papers by this authorGuangliang Shan, Corresponding Author Guangliang Shan [email protected] Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China Correspondence: Yong Zhong Department of Ophthalmology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College No. 1 Shuaifu Yuan, Dongcheng District, 100730 Beijing, China Tel: +86 13701182946 Email: [email protected] Guangliang Shan Department of Epidemiology and Statistics Institute of Basic Medical Sciences Chinese Academy of Medical Sciences 5 Dongdansantiao, Dongcheng District, Beijing 100005 China Tel: +86 18611968902 Email: [email protected].Search for more papers by this author First published: 17 November 2019 https://doi.org/10.1111/aos.14268 AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack 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Learn more.Copy URL Editor, Uncorrected refractive error was acknowledged as the most common causes of moderate and severe visual impairment (VI) and the second leading cause of blindness, and people aged 50 years or older represented 65% of VI and 82% of blindness cases(Pascolini & Mariotti 2012). Thus, it is necessary to figure out the current refractive status and risk factors in older adults. However, evidence on updated prevalence and risk factors of refractive error among Chinese adults aged 40 and over is sparse, and most of previous studies (Cheng et al. 2003; Xu et al. 2005, 2017; Liang et al. 2009) were conducted without urban–rural and ethnicity comparison. As an essential part of ‘The China National Health Survey’, an ongoing national representative and multi-ethnic survey conducted in urban and rural areas in different provinces in China, our study performed a population-based and cross-sectional investigation to survey the prevalence and risk factors of refractive errors in Hebei Province, China. Based on the level of urbanization, economic status and the distribution of ethnic, a multi-stage cluster sampling method was used to select participants aged 40 and over. A total of 3924 participants whose parents were with the same ethnicity were finally eligible for this study, including 1572 males and 2352 females; 2403 Han people and 1521 Manchu people. All of them underwent face-to-face questionnaire interview, physical and ocular examinations. In this study, the gender- and age-standardized prevalence of myopia, high myopia and hyperopia were 27.43% (95% CI: 25.9–28.97) and 2.29% (95% CI: 1.74–2.84) in total; 27.35% (95% CI: 25.43–29.27), 1.13% (95% CI: 0.80–1.83) and 26.48% (95% CI: 24.89–28.06) in Han population; 27.51% (95% CI: 24.95–30.06), 3.97% (95% CI: 2.72–5.21) and 22.22% (95% CI: 20.36–24.07) in Manchu people, respectively (Fig. Fig. 1). The prevalence of myopia, high myopia and hyperopia was 20.99% (95% CI: 19.31–22.68), 1.37% (95% CI: 0.88–1.86) and 31.18% (95% CI: 29.44–32.92) in urban areas and 28.67% (95% CI: 26.61–30.73), 2.69% (95% CI: 1.94–3.44), 26.30% (95% CI: 24.32–28.27) in rural areas. After adjusting for age, gender, ethnicity, individual monthly income, education level, family history of high myopia, residence and physical activity, the multivariable logistic regression model showed that people at 50–69 years old and with Manchu ethnicity (OR: 0.83; 95% CI: 0.70–0.98) had lower risk for myopia. Females (OR: 1.31; 95% CI: 1.10–1.57), people had higher education level and family history of high myopia (OR: 4.66; 95% CI: 1.63–13.27), were more likely to have myopia. Participants with Manchu ethnicity (OR: 2.03; 95% CI: 1.24–3.33) and had positive family history of high myopia (OR: 9.81; 95% CI: 1.77–54.28) were also at higher risk of high myopia. As for hyperopia, ageing, females (OR: 1.35; 95% CI: 1.31–1.62) were risk factors, but Manchu ethnicity (OR: 0.72; 95% CI: 0.61–0.86) and higher individual monthly income were protective factors. Comparing with urban areas, rural areas were not significant factors in myopia (OR: 0.95; 95% CI: 0.77–1.16), high myopia (OR: 0.72; 95% CI: 0.39–1.37) and hyperopia (OR: 1.02; 95% CI: 0.83–1.26). Figure Fig. 1Open in figure viewerPowerPoint Age- and sex-specific prevalence of myopia and hyperopia in adults aged 40 and over with different ethnicities or residence: (A) the age- and sex-specific prevalence of myopia in Han and Manchu adults; (B) the age- and sex-specific prevalence of myopia in urban or rural areas; (C) the age- and sex-specific prevalence of hyperopia in Han and Manchu populations; (D) the age- and sex-specific prevalence of hyperopia in urban or rural areas; (E) multivariable analyses of the risk factors of refractive errors. Since ethnicity was the significant risk factor for both myopia and hyperopia, the subgroup analysis was investigated between Han and Manchu adults with multivariate logistic regression models. With the same gender or education level, the Han population was more strongly correlated with the presence of myopia than Manchu adults; interestingly, the outcome was reversed when both ethnic groups had a family history of high myopia. Moreover, when the grade of individual monthly income was consistent, the hyperopic risk of Han adults was higher than that of Manchu adults. In conclusion, there were disparities between Han and Manchu population in disease profile of refractive errors. Comparing with Manchu, Han participants had higher risk of myopia and hyperopia, but lower risk of high myopia. However, residence was not an important risk factor for any refractive errors. References Cheng CY, Hsu WM, Liu JH, Tsai SY & Chou P (2003): Refractive errors in an elderly Chinese population in Taiwan: the Shihpai Eye Study. Invest Ophthalmol Vis Sci 44: 4630– 4638. Liang YB, Wong TY, Sun LP et al. (2009): Refractive errors in a rural Chinese adult population the Handan eye study. Ophthalmology 116: 2119– 2127. Pascolini D & Mariotti SP (2012): Global estimates of visual impairment: 2010. Br J Ophthalmol 96: 614– 618. Xu L, Li J, Cui T et al. (2005): Refractive error in urban and rural adult Chinese in Beijing. Ophthalmology 112: 1676– 1683. Xu C, Pan C, Zhao C, Bi M, Ma Q, Cheng J & Song E (2017): Prevalence and risk factors for myopia in older adult east Chinese population. BMC Ophthalmol 17: 191. Volume98, Issue3May 2020Pages e394-e395 FiguresReferencesRelatedInformation